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DONJON MARINE EMPLOYEE WELFARE PLAN 401k Plan overview

Plan NameDONJON MARINE EMPLOYEE WELFARE PLAN
Plan identification number 501

DONJON MARINE EMPLOYEE WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

DONJON MARINE CO INC has sponsored the creation of one or more 401k plans.

Company Name:DONJON MARINE CO INC
Employer identification number (EIN):221844615
NAIC Classification:423800

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DONJON MARINE EMPLOYEE WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-06-01RANDALL R. ROFFINA2022-12-21
5012020-06-01RANDALL R ROFFINA2022-03-04 JOHN A WITTE, JR2022-03-04
5012019-06-01RANDALL R. ROFFINA2021-02-03 RANDALL R. ROFFINA2021-02-03
5012018-06-01RANDALL R. ROFFINA2020-06-03 JOHN A. WITTE2020-06-03
5012017-06-01
5012016-06-01
5012015-06-01
5012014-06-01
5012013-06-01
5012012-06-01JOHN A WITTE
5012011-06-01JOHN A WITTE
5012010-06-01JOHN A WITTE
5012009-06-01JOHN A. WITTE

Plan Statistics for DONJON MARINE EMPLOYEE WELFARE PLAN

401k plan membership statisitcs for DONJON MARINE EMPLOYEE WELFARE PLAN

Measure Date Value
2021: DONJON MARINE EMPLOYEE WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-06-01282
Total number of active participants reported on line 7a of the Form 55002021-06-01271
Total of all active and inactive participants2021-06-01271
Total participants2021-06-01271
2020: DONJON MARINE EMPLOYEE WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-06-01284
Total number of active participants reported on line 7a of the Form 55002020-06-01282
Total of all active and inactive participants2020-06-01282
Total participants2020-06-01282
2019: DONJON MARINE EMPLOYEE WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01280
Total number of active participants reported on line 7a of the Form 55002019-06-01284
Number of retired or separated participants receiving benefits2019-06-011
Total of all active and inactive participants2019-06-01285
Total participants2019-06-01285
2018: DONJON MARINE EMPLOYEE WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-06-01284
Total number of active participants reported on line 7a of the Form 55002018-06-01281
Total of all active and inactive participants2018-06-01281
Total participants2018-06-01281
2017: DONJON MARINE EMPLOYEE WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-01622
Total number of active participants reported on line 7a of the Form 55002017-06-01494
Total of all active and inactive participants2017-06-01494
Total participants2017-06-01494
2016: DONJON MARINE EMPLOYEE WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01743
Total number of active participants reported on line 7a of the Form 55002016-06-01622
Total of all active and inactive participants2016-06-01622
Total participants2016-06-01622
2015: DONJON MARINE EMPLOYEE WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01747
Total number of active participants reported on line 7a of the Form 55002015-06-01743
Total of all active and inactive participants2015-06-01743
Total participants2015-06-01743
2014: DONJON MARINE EMPLOYEE WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01694
Total number of active participants reported on line 7a of the Form 55002014-06-01747
Total of all active and inactive participants2014-06-01747
Total participants2014-06-01747
2013: DONJON MARINE EMPLOYEE WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01811
Total number of active participants reported on line 7a of the Form 55002013-06-01694
Total of all active and inactive participants2013-06-01694
Total participants2013-06-01694
2012: DONJON MARINE EMPLOYEE WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01745
Total number of active participants reported on line 7a of the Form 55002012-06-01811
Total of all active and inactive participants2012-06-01811
2011: DONJON MARINE EMPLOYEE WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01671
Total number of active participants reported on line 7a of the Form 55002011-06-01745
Total of all active and inactive participants2011-06-01745
2010: DONJON MARINE EMPLOYEE WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-06-01517
Total number of active participants reported on line 7a of the Form 55002010-06-01671
Total of all active and inactive participants2010-06-01671
2009: DONJON MARINE EMPLOYEE WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01464
Total number of active participants reported on line 7a of the Form 55002009-06-01517
Total of all active and inactive participants2009-06-01517

Form 5500 Responses for DONJON MARINE EMPLOYEE WELFARE PLAN

2021: DONJON MARINE EMPLOYEE WELFARE PLAN 2021 form 5500 responses
2021-06-01Type of plan entitySingle employer plan
2021-06-01Plan funding arrangement – InsuranceYes
2021-06-01Plan benefit arrangement – InsuranceYes
2020: DONJON MARINE EMPLOYEE WELFARE PLAN 2020 form 5500 responses
2020-06-01Type of plan entitySingle employer plan
2020-06-01Plan funding arrangement – InsuranceYes
2020-06-01Plan benefit arrangement – InsuranceYes
2019: DONJON MARINE EMPLOYEE WELFARE PLAN 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan benefit arrangement – InsuranceYes
2018: DONJON MARINE EMPLOYEE WELFARE PLAN 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan benefit arrangement – InsuranceYes
2017: DONJON MARINE EMPLOYEE WELFARE PLAN 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – InsuranceYes
2016: DONJON MARINE EMPLOYEE WELFARE PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – InsuranceYes
2015: DONJON MARINE EMPLOYEE WELFARE PLAN 2015 form 5500 responses
2015-06-01Type of plan entityMulitple employer plan
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – InsuranceYes
2014: DONJON MARINE EMPLOYEE WELFARE PLAN 2014 form 5500 responses
2014-06-01Type of plan entityMulitple employer plan
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – InsuranceYes
2013: DONJON MARINE EMPLOYEE WELFARE PLAN 2013 form 5500 responses
2013-06-01Type of plan entityMulitple employer plan
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – InsuranceYes
2012: DONJON MARINE EMPLOYEE WELFARE PLAN 2012 form 5500 responses
2012-06-01Type of plan entityMulitple employer plan
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – InsuranceYes
2011: DONJON MARINE EMPLOYEE WELFARE PLAN 2011 form 5500 responses
2011-06-01Type of plan entityMulitple employer plan
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan benefit arrangement – InsuranceYes
2010: DONJON MARINE EMPLOYEE WELFARE PLAN 2010 form 5500 responses
2010-06-01Type of plan entityMulitple employer plan
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan benefit arrangement – InsuranceYes
2009: DONJON MARINE EMPLOYEE WELFARE PLAN 2009 form 5500 responses
2009-06-01Type of plan entityMulitple employer plan
2009-06-01This submission is the final filingNo
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 3
Insurance contract or identification number86551
Number of Individuals Covered271
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $5,850
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $177,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,850
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00564914
Policy instance 2
Insurance contract or identification number00564914
Number of Individuals Covered183
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $3,445
Total amount of fees paid to insurance companyUSD $1,567
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,445
Amount paid for insurance broker fees1567
Additional information about fees paid to insurance brokerADDITIONAL FEES
Insurance broker organization code?3
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 1
Insurance contract or identification number86551
Number of Individuals Covered271
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $88,537
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,303,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $88,537
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number099469
Policy instance 4
Insurance contract or identification number099469
Number of Individuals Covered295
Insurance policy start date2020-06-01
Insurance policy end date2021-07-01
Total amount of commissions paid to insurance brokerUSD $3,167
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $23,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,177
Insurance broker organization code?3
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 3
Insurance contract or identification number86551
Number of Individuals Covered282
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $5,932
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $174,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,932
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00564914
Policy instance 2
Insurance contract or identification number00564914
Number of Individuals Covered191
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $3,319
Total amount of fees paid to insurance companyUSD $433
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,319
Amount paid for insurance broker fees433
Additional information about fees paid to insurance brokerADDITIONAL FEES
Insurance broker organization code?3
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 1
Insurance contract or identification number86551
Number of Individuals Covered282
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $69,116
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,580,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $69,116
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number099469
Policy instance 2
Insurance contract or identification number099469
Number of Individuals Covered296
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $1,985
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $21,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,985
Insurance broker organization code?3
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 3
Insurance contract or identification number86551
Number of Individuals Covered284
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $5,633
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $173,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,633
Insurance broker organization code?3
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 4
Insurance contract or identification number86551
Number of Individuals Covered282
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $12,690
Welfare Benefit Premiums Paid to CarrierUSD $591,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,690
Insurance broker organization code?3
HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )
Policy contract number86551
Policy instance 5
Insurance contract or identification number86551
Number of Individuals Covered173
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $4,157
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,157
Insurance broker organization code?3
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 1
Insurance contract or identification number86551
Number of Individuals Covered282
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $67,815
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,448,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $67,815
Insurance broker organization code?3
HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )
Policy contract number86551
Policy instance 5
Insurance contract or identification number86551
Number of Individuals Covered166
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $3,631
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,631
Insurance broker organization code?3
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 4
Insurance contract or identification number86551
Number of Individuals Covered287
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $5,717
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $170,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,717
Insurance broker organization code?3
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 1
Insurance contract or identification number86551
Number of Individuals Covered288
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $70,294
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,332,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70,294
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number099469
Policy instance 2
Insurance contract or identification number099469
Number of Individuals Covered306
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $2,031
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $22,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,031
Insurance broker organization code?3
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 3
Insurance contract or identification number86551
Number of Individuals Covered288
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $13,876
Welfare Benefit Premiums Paid to CarrierUSD $639,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,876
Insurance broker organization code?3
HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )
Policy contract number86551
Policy instance 4
Insurance contract or identification number86551
Number of Individuals Covered151
Insurance policy start date2016-09-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $3,523
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 1
Insurance contract or identification number86551
Number of Individuals Covered279
Insurance policy start date2016-09-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $91,908
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,122,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number099469
Policy instance 2
Insurance contract or identification number099469
Number of Individuals Covered215
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $2,013
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $22,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number604175
Policy instance 3
Insurance contract or identification number604175
Number of Individuals Covered89
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $9,503
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFESTYLE ADD
Welfare Benefit Premiums Paid to CarrierUSD $63,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )
Policy contract number86551
Policy instance 5
Insurance contract or identification number86551
Number of Individuals Covered10
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $2,480
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,480
Insurance broker organization code?3
Insurance broker nameKORE HEALTH AND BENEFITS LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00304119
Policy instance 4
Insurance contract or identification number00304119
Number of Individuals Covered142
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $15,240
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $101,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,973
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000604175
Policy instance 3
Insurance contract or identification number000000604175
Number of Individuals Covered118
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $14,305
Other welfare benefits providedLIFESTYLE ADD; LIFESTYLE LIFE
Welfare Benefit Premiums Paid to CarrierUSD $64,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,305
Insurance broker organization code?3
Insurance broker nameKORE INSURANCE HOLDINGS LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number099469
Policy instance 2
Insurance contract or identification number099469
Number of Individuals Covered365
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $1,984
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $21,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,984
Insurance broker organization code?3
Insurance broker nameKORE INSURANCE HOLDINGS LLC
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 1
Insurance contract or identification number86551
Number of Individuals Covered367
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $124,842
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,015,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $124,842
Insurance broker organization code?3
Insurance broker nameKORE HEALTH AND BENEFITS LLC
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 1
Insurance contract or identification number86551
Number of Individuals Covered336
Insurance policy start date2014-06-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $29,555
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $840,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,555
Insurance broker organization code?3
Insurance broker nameKORE HEALTH AND BENEFITS LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number604174
Policy instance 3
Insurance contract or identification number604174
Number of Individuals Covered80
Insurance policy start date2014-08-01
Insurance policy end date2015-05-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number099469
Policy instance 2
Insurance contract or identification number099469
Number of Individuals Covered411
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $1,968
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $21,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,968
Insurance broker organization code?3
Insurance broker nameKORE HEALTH AND BENEFITS, LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number604175
Policy instance 4
Insurance contract or identification number604175
Number of Individuals Covered124
Insurance policy start date2014-08-01
Insurance policy end date2015-05-31
Other welfare benefits providedLIFESTYLE ADD/ LIFESTYLE LIFE
Welfare Benefit Premiums Paid to CarrierUSD $50,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number0010257106
Policy instance 5
Insurance contract or identification number0010257106
Number of Individuals Covered8
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $882
Other welfare benefits providedVOLUNTARY BENEFITS (ISTD)
Welfare Benefit Premiums Paid to CarrierUSD $2,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $882
Insurance broker nameKORE INSURANCE HOLDINGS LLC
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number86551
Policy instance 1
Insurance contract or identification number86551
Number of Individuals Covered338
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $113,822
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,309,911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $113,822
Insurance broker nameKORE HEALTH AND BENEFITS LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number099469
Policy instance 2
Insurance contract or identification number099469
Number of Individuals Covered356
Insurance policy start date2013-06-01
Insurance policy end date2014-06-01
Total amount of commissions paid to insurance brokerUSD $3,026
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $20,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,026
Insurance broker organization code?3
Insurance broker nameKARE HEALTH AND BENEFITS, LLC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number696717
Policy instance 1
Insurance contract or identification number696717
Number of Individuals Covered811
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $35,753
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $903,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,623
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES USA
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number000FG278
Policy instance 4
Insurance contract or identification number000FG278
Number of Individuals Covered172
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $13,666
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedOPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $91,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,666
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES USA
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number099469
Policy instance 3
Insurance contract or identification number099469
Number of Individuals Covered357
Insurance policy start date2012-06-01
Insurance policy end date2013-06-01
Total amount of commissions paid to insurance brokerUSD $1,019
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $19,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,019
Insurance broker organization code?3
Insurance broker nameTHE AIGIS GROUP LLC
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95287 )
Policy contract number696717-HNO
Policy instance 2
Insurance contract or identification number696717-HNO
Number of Individuals Covered652
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $111,106
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $134,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $101,786
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES USA
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number696717
Policy instance 1
Insurance contract or identification number696717
Number of Individuals Covered1709
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $40,174
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,218,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0101012
Policy instance 2
Insurance contract or identification number0101012
Number of Individuals Covered745
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $9,954
Total amount of fees paid to insurance companyUSD $900
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $107,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number696717-HNO
Policy instance 4
Insurance contract or identification number696717-HNO
Number of Individuals Covered1501
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $218,377
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $5,859,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract numberFG278
Policy instance 3
Insurance contract or identification numberFG278
Number of Individuals Covered161
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $11,595
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedOPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $77,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number696717
Policy instance 1
Insurance contract or identification number696717
Number of Individuals Covered1510
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $200,622
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,302,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract numberFG278
Policy instance 3
Insurance contract or identification numberFG278
Number of Individuals Covered154
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $11,313
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedOPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $75,417
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0101012
Policy instance 2
Insurance contract or identification number0101012
Number of Individuals Covered671
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $8,650
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $91,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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